Hemostatic tonsillotome.



B. 1). LA FORGE. HEMOSTATIG TONSI-LLOTOMB. APPLICATION I ILED DBO. 29,1913.

1 7 1 32 Patented May 19, 1914.

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i mw B. 1). LA FOROE.' HEMOSTATIGI TONSILLOTOME. APPLICATION FILED D30.29, 1913.

LQQ'ZJ 3 2, Patented May 19, 1914.

2 SHEETS-SHEET 2.

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. To all whom it may concern:

BURDEITE DUDLEY LA FORCE, 0E OT'LUiiIWA, IOWA.

HEIVIQSTATIG TQNSILLO$OME Specification of Letters latent.

Patented May 19, rate.

Application filed December 29, 1913. Serial N 0. 809,212.

. Be it known that I, Bunnn'r'rn DUDLEY LA FORCE, citizen of the UnitedStates, residing at Ottumwa, in the county of VVapello and State ofIowa, have invented certain new and useful Improvements in I-IemostaticTonsillotomes, of which the following is a specification.

This invention relates to improvements in surgical instruments of thetype called tonsillotomes, the primary purpose of which is to effect theremoval of tonsils, adenoid growths, and other more or less inaccessiblemembers or tissues.

While the instrument hereinafter de-' scribed is especially designed forremoving the faucial tonsils, the principles entering into itsconstruction and operation are such that it may be effectively used forother surgical operations which requires ligation,

' hemostasia and amputation, in rapid se quence, for their successfulcompletion.

The-especial object of the improvements which form the subject matter ofthis application, is to provide an instrument of the type stated, inwhich a ligator, hemostat and knife are so combined that they may be conveniently and effectively operated in rapid sequence, as compared withseparate instruments, thus requiring the patient to be under anesthesiafor the bricfest possible period, and by which a bloodless operation maybe performed.

A further object of my innprovcmcnts is to so combine the severalinstrumentalities which make up the complete device, that each willcomplement the other in effecting a the various steps required in acomplete op- Fig. 3 is an enlarged sectional view of the eration uponthe part removed.

A still further object of my improvements is to provide an instrumenthaving its members of strong and simple construction, so assembled thatthey may be readily disassembled for cleaning, and in which there willbe no inaccessible joints or crevices. I

Havin the aforegoing special objects, and others o general utility inmind, I have invented and designed the instrument herein shown,described and claimed in a preferred form, as follows c- In theaccompanying drawing :Figure 1 is a sideelevation, in full size, of afaucial hemostatic tonsillotome constructed according tomy invention;Fig. 2 is a to) plan View of the instrument shown in *ig. 1;

tonsil engaging terminals of the ligator,

hemostat and knife of my improved instrument; Fig. it is an enlargedplan view of the rear portion of the main frame of my improvedto-nsillotome; Fig. 5 is a top plan view of the knife member; Fig. 6 isa plan view of the hcmostat; Fig. 7 is a plan View of the ligator; Fig.8 is a fragmental view showing in elevation the upper portions of thehandle members of my invention, and- Fig. 9 is a detail of a springcatch which forms a feature of my invention.

Referring to the details of the drawing,

the reference character 10 represents the handle member of my improvedinstrument, and it is made up of the following parts A rearward graspingportion 10, a forward grasping portion 10 to the'inner opposed faces ofwhich ,are secured springs 10 adapted to force said grasping portionsapart, as shown in Fig. 1. The handles are pivoted together at 10*, andabove their pivoted points are formed with integral extensions 10 10respectively, the former serving as a lever adapted to operate certainother members of the instrument, and the latter or-part 10*, which isbifurcated having rectangular portions 10 at its upper end, one of whichis adapted to fit a correspond ing notch 11 in the main frame of theinstrument, to be hereinafter described. The terminals 10 have athreaded hole l0 formed therein, and the lever 10 has a curved notch 1Oformed in its inner edge as shown in Fig, 8. The member 10 is split, asindicated by dotted lines in Fig. 8, to receive the member 10 when thelatter is in its closed position, so that while one of the parts 10engages the notch 11 in the frame 11, the other portion 10*, passesthrougha suitable slot 11 at the other side of the frame, as shown inFig. 2. A thumb screw 10 has a threaded engagement with the holes 10 inthe portions 10 and by tightening said nut the two terminals 10 of thefork 10 are removably but firmly clamped upon the frame of theinstrument. The notch 1O in the inner edge of the member 10 provides forthe screw 10 when the two members 10, 10, are in their closed position.

11 represents generally the main frame of my improved instrument uponwhich the operating members are slidably mounted. This frame throughoutthe greater part of its length is substantially a fiat bar of steel, butat its rear portion is bent at right angles 'wardly from the rear end ofthe bar.

to provide a post 11, the end of which is perforated to provide spacedthreaded: eyes 11 The bar is also bent at 11 so that the portions 1111,and the connecting portion of the bar, form an open rectangular yoke,as clearly shown inFig. 1. One edge of the bar adjacent the bond 11 iscut away to provide the rectangular notch 11. The bar is furtherprovided with a small diamond shaped slot 11 a slot 11 near the edge,opposite the notch 11, and an elongated slot 11 extending longitudinallyof the bar between the slot,11 and the notch 11. The forward end of thebar is formed into a rectangular yoke 11 in the inner walls of which areslidcways 11, 11 and the cross bar at the end of the yokeis slit toprovide a passageway 11 (see Fig. 3) for the knife 12. l p

The reference character 12 represents the knife member of my improvedinstrument, the same consisting of a thin steel bar,-fiat throughout thegreater part of its length as shown in Fig. 5, but provided at its rearend with a lug 12 at right angles to the bar, through which lug is anopening 12*. The bar is also provided with two slots 12, 12 extendinglongitudinally thereof, and at its forward end the bar is widened'andprovided with a beveled cutting edge 12. The knife rests upon the frame11 and is mounted to slide in the groove 11 in said frame.

As best shown in Fig. 6,the hemostat member, 13, of my improvedinstrument consists of a flat bar of steel except for the threaded stem13, which extends rear- There are two longitudinal slots 13, 13, in saidbar, and along one edge are ratchet teeth 13 Near the forward end of thebar, and on the upper surface, are small guide lugs 13*, and the forwardend portion of the bar is widened and provided on its edges with flanges13. adapted to engage the groovesor slideway 11 in the frame 1.1. Theforward end of the hemostatic bar is provided with serrations or teeth13 which are adapted to cooperate with similar teeth formed on theopposed edge of the yoke 11 in the gripping or crushing of the tonsil.

The ligator member, 14, or ligature carrier, of my improved instrumentis shown in plan view in Fig. 7 and same consists of a thin flat barthroughout the greater portion'of its length, but at its rear portion isprovided with a triangular shaped lug 14, which serves as a suitablefinger-engaging portion of this member, its surface being preferablyroughened to prevent slippage of the fingers of the operator. Thismember 11, is also provided with an elongated slot 14, and its forwardend is made tapering and somewhat i thinner than the body of the member,and 3 is rounded as at 11. and in the extreme end 3 isadapted to receivethe ligature 1 1 the ends of which are held by the spring clip one endof which is a post 15 which terminates at its free end in a transversetongue 15. The opposite end of the latch is formed with spreadingangular extensions 15 which are adapted to embrace the lower edge andsides of the bar 11 when the latch is in operative position, and when inthis position, the post or stem 15 will pass through the slots 11, 12,and 13, and the diamond shaped end 15 of the stern will extend crosswiseof the diamond shaped slot 11 ,"VVhen itis desired to discharge thecatch, the end 15 is forced downwardly against the tension exerted bythe opposite end and the catch is given a quarter turn, thus bringingthe end 15 into registry with are slot 11, so that it can be drawnthrough the-slot. As best shown in Fig. 2, a thumb screw 16, has athreaded engagement with the eyes 11 at the rear end of the frame 11,and serves to guide the stem 13" which passes below saidsscrew.

Mounted upon the threaded stem 13, is a wheel 17 which, when screwed byturning to the left to the point shown in Fig. 1, in which itimpingesagainst the end of the arm 11, serves as a lock-nut against thelongitudinal mbvement of said stemwhen the forward end of the hemostatis in its most forward position, but when a longitudinal movement of theheme-static member or bar of'which said threaded stem is an extensionindependently of the handle is desired, such movement is effected by therotation of said nut 17 to the left and it also forces forward theknife. by reason of the, connection between the rear end of the knifeand stem 13, which is effected by the hub extension 18 on the nut 18.When it is desiredto move the knife independently of the hemostat andthe handle lever, the nut 18 is turned to the right or left, dependingupon whether it is desired to feed the knife forward or backward.

The reference character 19. represents a pawl pivotally mounted on apin20 in the frame 11, and adapted to have its point 19 held in operativeengagement with the teeth 11 of the hemostat by the expansive action ofa spring 21, when said hemostat is in position that will bring saidpoint in the path of said teeth. The handle extension arm or lever 10engages the slots 11*. 12 13", and 11 and serves to push forwardly theknife and hemostat a certain distance when the handle members 10*, 10",are brought close 65 of the rounded portion is a groove 14 which 1together by the operator. lVhen thus operated the pawl 19, by engagingthe teeth 13 will hold the parts in such position. until the pawl ismanually released.

The method of procedure in the use of the hemostatic tonsillotome is asfollows :The faucial tonsil is engaged into the fenestrum of theinstrument by placing the yolte 11 around it and all of the tissuesimmediately in. apposition to. the capsule of the tonsil are thoroughlycrushed by pressing the handles of the instrument tightly together, thusbringing the hemostat in close engagement with the tissues immediatelyback of the capsule, in which position it is held by the engagement ofthe pivotal pawl with the teeth provided therefor on the edge of therear ,portion of the hemostat bar. Thenext step to further crush thetissues and clamp them effectively in the hemostat yoke, is accomplishedby turning the wheel 1'? to the left, so that it will impinge againstthe end 11 of the main frame. After the tissues are thoroughly crushed,the ligator or ligature carrier, with a ligature looped over the end Li,and in the groove 14:, and held under tension by the spring catch li ispushed forwardly, piercing the tissues clamped by the hemostat.Whereupon the ligature is slaclrened by disengaging it from the catch,the ligator retracted, thus leaving the loop end of the ligature on thefarther side of the tissues, where it may be grasped by suitableinstruments, the loop brought around the rear end of the instrument andthe ligation completed by tying the ligature down tightly against thetissues under compression. This'ligation operation may be repeated in asmany places as the size of the member operated upon may require. Afterthese operations are performed, the operating nut 18 is turned to theright thereby sliding the knife tl irough the groove provided thereforin the frame, and severing the tonsil or part operated uponiinmediatelyadjacent the heinostat. The hemostat then released by turning the nut 17to the right and releasing the pawl 19, thereby allowing the springs{10C to expand the handles, and retracting the knife and hemostat. Theseveral operations described effect the complete enuoleation of thetonsil without hemorrhage;

1. A surgical instrument comprising a fixed frame having a fenestruni atits forward end, a pair of handles detachably connected. wit-l said'frame, one of said handles being pivotally connected with the otherand'having an arm extending through said frame, 'a hemostat bar slidablyarranged on said frame, a knife slidable on said frame, and a ligatorslldahle on said hemostat bar, said bar and knife adapted to be operatedby said arm and to enter said yoke.

2. A surgical instrument comprising a fixed frame having a fenestrum atits forward end, a pair of handles detachahly conneoted with said frame,one of said handles being pivotally connected with the other and havingan arm extending through said frame, a hemostat bar slidably arranged onsaid frame, a, knife slidable on, said frame adjacent said bar, aligator slidable on said hemostat bar, vsaid loar and lrnife adapted tobe operated by said arm and to enter said yoke, and means for lockingsaid bar in operative position.

3. A surgical instrument comprising a fixed frame having a fenestrum atits forward end, apair of handles connected with said frame, one of saidhandles being pivoted to the other and having an arm extending throughsaid frame, a hemostat bar slidably mounted on said frame and having aslot operatively engaged by said arm,

a knife slidably mounted on said frame and having a slot o-perativelyengaged by said arm, means for locking said bar in operative position,and means for detachably connecting said bar and knife with said frame.

4 A surgical instrument comprising a frame having a fenestrum at itsforward end, a pair of handles connected with said frame, a heniostatbar slidably mounted on said frame, and adapted to enter saidfenestruni, a knife slidably mounted on said frame, means for operatingsaid bar and knife, means for locking said bar in operative position,and means for detachably connecting said bar and knife with said frame.

5. A'surgical instrument, a frame having a fenestrum at its forward end,a pair of handles connected with said frame, a hemostat oar slidablymounted on said frame, and adapted to enter said fenestrum, means foroperating'said bar from said handles to be operated on, a ligatorslidable on said hemostat, means for operating said ligator, means forholding a ligature under tension on said ligator, means for operatingsaid hemostat, and means for locking said hemostat in operativeposition:

8, In a surgical instrument, a supporting m mber, a hemostet, a ligatorand a knife, In testimony whereof I aflix my signature shdably arranged111 superposed relatlon on m the presence of two w1tnesses. said frame,lndependent means for operat- BURDETTE DUDLEY LA FORCE- ing szudhemostat, hgator and knlfe, and Vitnesses:

a means for locking the hemostat in oper- J. A. HULL,

ative position. ELMER J. LAMBERT.

